1. What are the critical skills a CEO brings?
2. What are the professional obligations of the CEO?
3. How does the board know that those skills are present and those obligations fulfilled?
4. What makes the relationship effective, and what erodes the relationship?

1.  The CEO and the senior management team are often the only people in the community who are professionally trained in healthcare delivery.  The training covers technical questions of need, demand, finance, quality, efficiency, law, and government regulation that are not included in the training of doctors, lawyers, or businesspersons.  Other skills that are needed are leadership, strong communication skills, familiarity with the community, a record of success in the healthcare industry and with business decisions.

2

To the HCO, the CEO is accountable for the clinical care quality standards, the financial health of the organization, and effective management.  Additionally, the CEO has several obligations such as supporting external and board relationships, the internal organization, and the medical/professional staff.   The CEO must understand the components of an organization’s bylaws

3.

The board established a process for hiring a CEO and within that process identified specific criteria.   The criteria should cluster around clear elements.  For example, there should be a description of duties and responsibilities. The job description should be translated into selection criteria identifying the skills and attributes of the individual. The priority or importance of these criteria and the ways in which these skills will be measured in specific applicants should be specified. 

4.

Four elements are most likely to impact the relationship.  These are:

1.  Develop a mutual understanding of the employment contract
2. Agree on short-term (usually one year) goals
3. Establish the base compensation
4. Establish incentives for goal achievement

Effective relationships between the board and the CEO are forged initially on these four elements.  Erosion of the relationship is likely due to:

1.  Inconsistent communication
2.  Separate agendas
3.  Dissimilar visions